小细胞肺癌的CT分型与影像特征分析

目的探讨小细胞肺癌(SCLC)特征性CT表现。方法回顾性分析经病理证实的53例SCLC患者的CT图像,将SCLC分为肺门肿块(I型),肺门肿块伴同侧纵隔淋巴结肿大(II型),肿块与淋巴结分界清晰(IIa)或不清晰(IIb),肺门肿块伴双侧纵隔淋巴结肿大(III型),肿块与同侧淋巴结分界清晰(IIIa)、不清晰(IIIb)或与双侧淋巴结融合(IIIc),周围型肿块(IV型)。结果53例中IIb和IIIb与IIIc共22例,占41.5%。病变多累及支气管,伴有支气管狭窄或梗阻40例(75.5%),中央型SCLC常见病灶侵犯血管32例(60.4%)、胸膜22例(41.5%)、肺实质34例(64.2%)等表现。通过Pearson相关性分析得出血管受累、胸膜病变及肺内伴随表现均与肿瘤的位置及纵隔浸润程度呈正相关。结论小细胞肺癌特征性CT表现就是肺门肿块伴纵隔融合性肿块。中央型SCLC大多累及支气管、大血管与胸膜。     

实时灰阶超声造影在乳腺肿瘤诊断中的应用研究

目的探讨实时灰阶超声造影对乳腺肿瘤良恶性鉴别的价值。方法52例乳腺肿块患者（25例良性,27例恶性）,利用第二代造影剂SonoVue及Technos DU8实时造影匹配成像技术,对比分析良恶性肿瘤的增强模式、时间-强度曲线及造影参数。结果恶性肿瘤多呈不均匀性增强,良性病变以均匀性增强为主（P〈0.01）。时间-强度曲线在良性组以快进快出型（12/25）及慢进快出型多见（8/25）,而恶性组以快进慢出型为主（19/27）。造影参数分析显示两组间在斜率、第90s增强比、峰值至90s曲线下面积及增强程度的差异有显著性意义（P〈0.05）,且恶性组均高于良性组。结论实时灰阶超声造影能清晰显示肿瘤微血管灌注,有助于乳腺肿块的良恶性评估。     

超声造影微血管成像与常规超声靶向引导前列腺癌穿刺活检的比较研究

ObJective To evaluate the value of contrast-enhanced ultrasonography microflow imaging (MFI) in detecting prostate cancer. Methods Sixty-five patients with serum prostate-specific antigen levels higher than 4.00 μg/L were evaluated with transrectal gray-scale,power Doppler,and MFI ultrasonography and then biopsy guided by ultrasonography. Biopsy was performed at twelve sites in the base,the mid gland and the apex in each patient. In these three transverse sections, when any of the three methods showed abnormality,the biopsy site was directed to the abnormal foci. Diagnostic efficiency of the three methods for prostate cancer detection was compared based on biopsy results according to patient and biopsy site. Results Overall prostate cancers were detected in 230 (29.5 %) of 780 specimens in 36(55.4%) of 65 patients. MFI could detect more patients(34) than gray-scale(26) and power Doppler(28) (P = 0.021, P = 0.031), 6(16.7%)of the 36 patients diagnosed with cancer were identified only by MFI. By biopsy site, MFI had higher sensitivity and overall accuracy (80.0% and 83.0%) than gray-scale (47.0% and 76.8%) and power Doppler (37.4% and 74.6%) ultrasonography(P <0.001, P<0.001 ; P = 0.001, P <0.001), while the specificity of MFI was 84.4%, lower than gray-scale (89.3%) and power Doppler (90.2%) ultrasonography(P = 0.009, P < 0.001). Conclusions MFI could detect more patients and improve sensitivity and overall accuracy by biopsy site than conventional uhrasonography.     

不同剂量氯胺酮对兔严重烧伤早期全身炎症反应的影响

目的：比较不同剂量氯胺酮对严重烧伤兔早期炎性细胞因子的影响,初步探讨其对创伤应激早期炎症反应的调节作用。方法选择健康雄性新西兰兔40只,按随机数字表法分正常对照组、烫伤模型组、氯胺酮镇痛组和氯胺酮麻醉组。烫伤前用戊巴比妥钠麻醉后分别经颈内静脉和颈内动脉置管备用,24 h后制备兔背部和臀部30%Ⅲ度烫伤模型,氯胺酮镇痛组于伤后0.5 h静脉注射（静注）氯胺酮负荷量0.5 mg/kg,然后持续静脉泵注氯胺酮9μg·kg-1·min-1共24 h;氯胺酮麻醉组伤后0.5 h静注氯胺酮1.5 mg/kg,然后持续静脉泵注氯胺酮45μg·kg-1·min-1共4 h维持全身麻醉;正常对照组和模型组仅给予静脉输液处理。记录各组补液量及氯胺酮镇痛组和麻醉组的氯胺酮总用量。分别于烫伤前和烫伤后0.5、6、12、24 h进行动脉血气分析,并检测血清白细胞介素（IL-1、IL-6）及肿瘤坏死因子-α（TNF-α）水平。结果4组血气分析指标虽然有所变化,但均在正常范围,说明呼吸功能在正常范围,间接反映循环功能也在正常范围,排除了呼吸和循环功能因素的影响对细胞因子的评判。4组烫伤前IL-1、IL-6及TNF-α水平比较差异均无统计学意义（均P＞0.05）。伤后0.5 h起,烫伤模型组IL-1（ng/L：30.27±0.93比13.79±1.11）、IL-6（ng/L：47.22±1.49比46.31±4.12）及TNF-α（ng/L：243.39±20.85比190.95±14.97）水平即均显著高于正常对照组（均P＜0.05）,并持续到伤后24 h;伤后6 h起氯胺酮镇痛组和麻醉组上述指标均较烫伤模型组明显降低,于伤后12 h起氯胺酮镇痛组上述指标的降低程度较氯胺酮麻醉组更显著〔IL-1（ng/L）：19.28±2.51比40.12±10.31,IL-6（ng/L）：52.10±4.23比72.20±10.11, TNF-α（ng/L）：246.03±20.74比313.71±27.34,均P＜0.05〕。结论小剂量氯胺酮镇痛和氯胺酮麻醉对兔严重烧伤后早期炎性细胞因子的表达和释放有一定抑制作用,且长时间小剂量氯胺酮镇痛效果更明显。     

超声造影导向活检在常规超声检查阴性前列腺癌的应用价值

目的 评价超声造影匹配成像(CnTI)技术在靶向引导常规超声无可疑前列腺癌病灶前列腺穿刺活检中的临床应用价值。方法 对56例因血清前列腺特异性抗原(PSA)升高(≥4.00 ng/ml)而常规超声未发现明确病灶的患者在穿刺前行经直肠前列腺CnTI实时扫查。在超声引导下对患者行底、中、尖三切面10点穿刺,如相应穿刺点有可疑病灶,则直接对病灶进行活检。统计分析CnTI实时扫查图像结果与病理结果。结果 56例患者共穿刺560针,穿刺病理诊断为前列腺癌11例(11/56,19.64%)共39针(39/560,6.96%),CnTI实时扫查检出7例(7/11,63.64%)共22针(22/39,56.41%)。在4例CnTI实时扫查假阴性病例中,2例仅有1针穿刺点阳性,1例2针穿刺点阳性,1例3针穿刺点阳性,其Gleason分值均为6分。CnTI实时扫查真阳性与假阴性前列腺癌穿刺点Gleason分值差异无统计学意义(6.9 vs 6.6, P=0.134)。结论 对血清PSA升高但常规超声未发现明确前列腺癌病灶的患者,经直肠前列腺CnTI实时扫查有助于检出前列腺癌可疑病灶并指导前列腺穿刺活检。     

miR-18a和miR-18b在结肠癌中的表达及其临床意义

目的 探讨miR-18a和miR-18b在结肠癌中的表达及其临床意义.方法 选取手术切除的原发性结肠癌标本20例,采用实时荧光定量PCR分析miR-18a和miR-18b的表达.结果 相对于癌旁组织,20例结肠癌组织中miR-18a表达下调(P＜0.05);其表达与TNM分期及浸润深度有关(P＜0.05).而miR-18b在癌组织中的表达则上调(P＜0.05),其表达与TNM分期、浸润深度和远处转移无明显关联.结论 miR-18a可能参与了结肠癌的发展.     

下调AP-1基因表达在冬凌草甲素抑制结直肠癌中的作用

目的 探讨冬凌草甲素对结自肠癌的抑制作用及其机制.方法 以冬凌草甲素水溶液处理LoVo和SW480结直肠癌细胞株,噻唑蓝(MTT)比色法检测细胞增殖抑制率,以Illumina表达芯片检测LoVo细胞和SW480细胞基因表达的变化,对变异的基因进行定量逆转录-聚合酶链反应(RT-PCR)检测,建立结肠造口的结肠癌原位移植模型,以冬凌草甲素水溶液对动物模型进行腹腔注射,观察肿瘤的增殖并对上述发现的相关变化基因进行RT-PCR检测.结果 冬凌草甲素在25 mg/L剂量即对LoVo细胞和SW480细胞产生80%以上的抑制率,而且随药物剂量升高和时间延长,抑制率呈逐渐上升趋势;经冬凌草甲素处理后基因表达发现在LoVo结直肠癌中冬凌草甲素可以明显促进CKS2、SFN、SERTAD1、HERC5、RECQIA、GADD45AQ、bax、bxl-2等基因的表达,明显抑制了AP-1、NFkb和p38;而在SW480结直肠癌中冬凌草甲素可以促进ABCG1、ERCC1、HERC5、TERF2IP和TERF2IP等基因表达;与对照组比较,应用冬凌草甲素处理后的结肠癌结肠造口原位移植模型肿瘤生长速度明显低于对照组(P＜0.01),而SW480结直肠癌和LoVo结直肠癌在冬凌草甲素处理后肿瘤的生长速度差异无统计学意义(P＞0.05).在肿瘤模型中仅仅发现AP-1基因表达下调,其余的基因均无上调或下调,在4周时定量RT-PCR检测发现,不仅AP-1基因下调,而且核因子(NF)-κB和p38明显下调.结论 冬凌草甲素体外和体内研究都能明显抑制结直肠癌肿瘤的增殖,而且对2种肿瘤细胞株抑制率差异无统计学意义;在体外研究中发现冬凌草甲素可能抑制多种基因的信号转导途径,但是在在体研究中,只发现AP-1、NF-kB和P38下调,而且AP-1基因下调出现要早于其他2个基因,提示AP-1基因的下调可能是冬凌草甲素抑制结直肠癌的早期事件,AP-1抑制可能影响了NF-kB和MAKP途径基因表达从而发挥抑制肿瘤的作用.

Abstract：

Objective Oridonin is the active ingredient isolated from the Chinese herb Rabdosia rubescens. We used both in vivo and in vitro approaches to elucidate the underlying mechanism of the oridonin-mediated inhibition of colorectal cancer. Methods Two colorectal cell lines, LoVo and SW480,were treated with oridonin in solution. The effect of this treatment on inhibition of cell proliferation rate was determined by the methyl thiazol tetrazolium (MTT) method. The changes in gene expression that occurred in both cell lines in response to treatment with oridonin were determined via illumine expression sensor.Additionally, a colorectal cancer colostomy implantation model was established. Animals were injected intraperitoneally with an oridonin solution. Results Treatment of LoVo and SW480 cells with oridonin inhibited cell proliferation in a dose-dependent manner. The inhibition rate was increased with prolonged treatment. The growth rate of the colorectal cancer colostomy implantation model was significantly lower than control cells when treated with oridonin ( P ＜ 0. 01 ). However, oridonin treatment did not have a signiticant effect on tumor growth rate ( P ＞ 0. 05 ). In the tumor model, AP-1 was the only gene found to be downregulated after oridonin treatment by the gene expression sensor. After 4 weeks of treatment, AP-1,nuclear factor-κB (NF-κB) and p38 were all found to be downregulated. Conclusion Our study has confirmed the inhibitory effects of oridonin on colovectal cancer. These results indicate that the downregulation of AP-1 might be an initial response to treatment by oridonin. This regulation could, in turn, affect the expression of the NF-κB and MAPK pathways, thereby inhibiting tumor growth.     

腮腺良性病变的CT表现及鉴别诊断

目的:探讨腮腺良性病变的CT表现和诊断价值。方法:回顾性分析经病理证实的腮腺良性病变20例CT表现。结果:20例良性病灶中,其中右侧病变9例,左侧病变11例;腮腺浅叶病变14例,深叶病变3例,浅深叶交界病变3例;2例良性病变边缘不清,术前误诊为恶性肿瘤。结论:大部分腮腺良性病变CT动态扫描能够正确诊断。